13.8: The Social-Ecological Model
The Social-Ecological Model is a framework for identifying the causes, risk factors, and protective factors that contribute to health outcomes in a community and populations at large. This model asserts that health outcomes - and perhaps more specifically, health behaviors - are influenced by the interaction between an individual, their community, and the physical, social, and political environments in which they live. Figure 13.7 is a visual representation of this model.
Each circle describes specific risk factors or protective factors for a health outcome, and therefore also provides opportunities for public health approaches at each level.
- The individual circle includes each individual’s own risk factors or protective factors. Genetics, age, personal history, education, income, attitudes, beliefs, and behaviors are included in this circle. All of these factors can make a person more or less likely to engage in a specific health behavior, and have an effect on their health status. For example, a person who experienced childhood trauma or abuse may be more likely to abuse drugs or drink alcohol. Someone who never graduated from high school may earn less income over their lifetime, and therefore not have consistent access to healthcare - or even avoid going to the doctor over concern about the medical costs. In a more positive example, a person who has experienced the benefits of eating a healthy diet and being physically active as a child is more likely to continue those healthy habits into adulthood - particularly because they may have a positive attitude towards nutrition and exercise.
- Relationships with other people are highly influential in a person’s attitudes, beliefs, and behaviors - and vice versa - these relationships are influenced by that person. Primary relationships are especially important, and include a significant other or spouse, parents, siblings, and children, as well as close friends. If a person is part of an abusive relationship, they will probably be more likely to be the victims of or to perpetrate violence. Conversely, if a person has a physically active friend group, they are more likely to engage in physical activity themselves.
- The community level includes organizations that the individual is a part of, and the broader social context in which they live. This could also include the built environment, and socio-political landscape of that person’s community. An example of this could be the social support provided by schools, churches, sports and recreation clubs. A built environment could encourage less stress and physical activity with accessible parks and greenspaces, or it could promote higher stress levels and alcohol consumption with high traffic roads and several liquor stores in the neighborhood.
- At the societal level we also have social norms, macro-economic and political factors, and environments that affect health outcomes. For example, social norms around alcohol consumption influence alcohol use at young ages, alcohol abuse, and addiction. Economic poverty is associated with higher crime rates, drug abuse, and mental illness. Political administrations can create laws that support or undermine public health efforts, and either provide or cut funding to public health programs ( The Social-Ecological Model: A Framework for Prevention , 2022, McKenzie et al., 2016).